Subcommittee on Hyperbilirubinemia An Evidence-Based Review of Important Issues Concerning Neonatal

ABSTRACT. This article is adapted from a published evidence report concerning neonatal hyperbilirubinemia with an added section on the risk of blood exchange transfusion (BET). Based on a summary of multiple case reports that spanned more than 30 years, we conclude that kernicterus, although infrequent, has at least 10% mortality and at least 70 % long-term morbidity. It is evident that the preponderance of kernicterus cases oc-curred in infants with a bilirubin level higher than 20 mg/dL. Given the diversity of conclusions on the rela-tionship between peak bilirubin levels and behavioral and neurodevelopmental outcomes, it is apparent that the use of a single total serum bilirubin level to predict long-term outcomes is inadequate and will lead to con-flicting results. Evidence for efficacy of treatments for neonatal hyperbilirubinemia was limited. Overall, the 4 qualifying studies showed that phototherapy had an ab-solute risk-reduction rate of 10 % to 17 % for prevention of serum bilirubin levels higher than 20 mg/dL in healthy infants with jaundice. There is no evidence to suggest that phototherapy for neonatal hyperbilirubinemia has any long-term adverse neurodevelopmental effects. Transcutaneous measurements of bilirubin have a linear correlation to total serum bilirubin and may be useful as screening devices to detect clinically significant jaundice and decrease the need for serum bilirubin determina-tions. Based on our review of the risks associated with BETs from 15 studies consisting mainly of infants born before 1970, we conclude that the mortality within 6 hours of BET ranged from 3 per 1000 to 4 per 1000 ex-changed infants who were term and without serious he-molytic diseases. Regardless of the definitions and rates of BET-associated morbidity and the various pre-ex-change clinical states of the exchanged infants, in many cases the morbidity was minor (eg, postexchange ane-mia). Based on the results from the most recent study to report BET morbidity, the overall risk of permanent se-quelae in 25 sick infants who survived BET was from 5